Poor prognosis indicated by nucleated red blood cells in peripheral blood is not associated with organ failure of the liver or kidney.

BACKGROUND: The appearance of nucleated red blood cells (NRBCs) in peripheral blood is associated with a variety of severe diseases. When NRBCs are detected in blood, this is generally associated with increased mortality. METHODS: In a prospective study, NRBCs and other laboratory parameters were measured daily in the peripheral blood of surgical intensive care patients. The appearance of NRBCs was analyzed in relation to laboratory indicators of organ injury. RESULTS: A total of 284 surgical intensive care patients were included in this study. The mortality of NRBC-positive patients was 44.0% (40/91). This was significantly higher (p<0.001) than the mortality of NRBC-negative patients (4.2%, 8/193). Mortality increased with the NRBC concentration and the length of the NRBC-positive period. Multiple logistic regression analysis of several other clinical and laboratory risk indicators revealed a significant association between NRBCs and increased mortality, with an odds ratio of 1.95 (95% CI 1.35-2.82; p<0.001) for each increment in NRBC category (0, 1-40, 41-80, 81-240 and >240 NRBC/microL). After the initial detection of NRBCs in blood, there were no significant increases in creatinine concentrations or alanine aminotransferase activity. However, the appearance of NRBCs coincided with increasing C-reactive protein and thrombocyte concentrations. CONCLUSIONS: The detection of NRBCs in blood of surgical intensive care patients is of prognostic power with regard to patient mortality. This prognostic significance of NRBCs was independent of some clinical and other laboratory risk parameters. The appearance of NRBCs in blood was not associated with kidney failure or lesion of the liver.     

Daily monitoring of nucleated red blood cells in the blood of surgical intensive care patients

BACKGROUND: In intensive care patients the appearance of nucleated red blood cells (NRBC) in blood is associated with a variety of severe diseases. Generally, when NRBCs are detected in the patients' blood the prognosis is poor. MATERIAL AND METHODS: In the present study the detection of NRBCs was used for a day-to-day monitoring of 284 surgical intensive care patients. RESULTS: NRBCs were found at least once in 32.0% of all patients. The mortality of NRBC-positive patients was 44.0% (40/91); this was significantly higher (P<0.001) than the mortality of NRBC-negative patients (4.2%, 8/193). With regard to intensive care mortality, NRBCs in blood showed sensitivity and specificity of 83.3% and 78.9%, respectively. The area under curve (C-statistic) was 0.86. Mortality increased with increasing NRBC concentration. All patients with more than 2000 NRBCs/microl died. Moreover, mortality increased with increasing frequency of occurrence. When after first detection of NRBCs in blood, during the further course of intensive care treatment the NRBCs have disappeared from the circulation, the mortality again decreased to values of NRBC-negative patients. The detection of NRBCs is associated with an increased mortality rate, the odds ratio after adjustment for other laboratory prognostic indicators being 1.8 (P<0.001) for each increase in the NRBC category (1-40/microl; 41-80/microl; 81-240/microl, >240/microl). NRBCs were detected for the first time, on average, 9 days (median 5 days) before death. CONCLUSIONS: The routine analysis of NRBC in blood is of potential prognostic power with regard to mortality of critically ill patients. Therefore, this parameter could possibly serve as a daily indicator of patients at high mortality risk.     

High in-hospital mortality of intensive care patients with nucleated red blood cells in blood.

The detection of nucleated red blood cells (NRBCs) in blood of patients suffering from a variety of severe diseases is known to be highly associated with increased mortality. Blood analyzers to routinely measure NRBC concentrations are now available. However, the diagnostic and prognostic significance of this parameter for intensive care patients has not been evaluated. Using a Sysmex XE-2100 analyzer, NRBC concentrations were determined in blood samples from 421 patients treated in intensive care units (general and accident surgery, cardiothoracic surgery, and internal medicine) of a university hospital. NRBCs were found at least once in 19.2% of all patients. The mortality of NRBC-positive patients (n=81) was 42.0% (n=34); this was significantly higher (p<0.001) than the mortality of NRBC-negative patients (5.9%, n=340). The NRBC concentration was 115+/-4x10(6)/l (median 40x10(6)/l; range 20-2930x10(6)/l) at initial detection of NRBCs in the blood. Mortality increased with increasing NRBC concentration and increasing frequency of occurrence. With regard to in-hospital mortality, NRBCs in blood showed sensitivity and specificity of 63.0% and 87.2%, respectively. The detection of NRBCs is highly predictive of death, the odds ratio after adjustment for other laboratory prognostic indicators being 1.01 (p<0.01) for each increase in the NRBC concentration of +1x10(6)/l. NRBCs were detected for the first time, on average, 13 days (median 8 days) before death. The routine analysis of NRBCs in blood is of high prognostic power with regard to in-hospital mortality of critically ill patients. Therefore, this parameter may serve as an early indicator for patients at increased mortality risk.     

外周血出现有核红细胞患者网织红参数与乳酸脱氢酶分析的意义

目的观察外周血出现有核红细胞(NRBC)患者网织红细胞参数与乳酸脱氢酶(LDH)水平的改变情况及其临床意义。方法应用XE-2100全自动血细胞分析仪检测住院病人抗凝全血标本,对NRBC计数阳性的58例病例,检测标本中网织红参数,同时应用Roche-Module D2400全自动生化分析仪,检测该病人血清中LDH水平。并将144例外周血未检出NRBC的住院病人设为对照组。结果外周血检出NRBC 58例患者分布于18个不同科室。外周血检出NRBC患者与外周血未检出NRBC病人网织红百分率(RET%)、高荧光强度网织红百分率(HLR%)、中荧光强度网织红百分率(MLR%)、LDH水平均有显著性差异(P<0.001)。结论外周血出现NRBC患者RET%,HLR%,MLR%和LDH水平明显升高,结合网织红参数和LDH水平有助于对外周血出现NRBC患者的病因诊断和预后评价。     

Nucleated red blood cells indicate high risk of in-hospital mortality

The presence of nucleated red blood cells (NRBCs) in the blood of patients with a variety of severe diseases is known to be highly associated with increased mortality. Blood analyzers to routinely measure NRBC concentrations are now available. However, the prognostic significance of such measurements has not been evaluated. Using a Sysmex XE-2100 (Sysmex; Norderstedt, Germany), we measured NRBC concentrations in 15,541 blood samples from 4,173 patients at a university clinic over the course of 12 weeks. NRBCs were found at least once in 7.5% of all patients. The highest incidence (20.0%) was found in patients from the intensive care unit of the general and accident surgery. The incidence of NRBC increased with age. The mortality of NRBC-positive patients (n = 313) was 21.1% (n = 66); this was significantly higher (P <.001) than the mortality of NRBC-negative patients (1.2%, n = 3,860). Mortality increased with increasing NRBC concentration. With regard to in-hospital mortality, NRBCs in blood showed sensitivity and specificity of 57.9% and 93.9%, respectively. NRBCs were detected for the first time, on average, 21 days (median 13 days) before death. The routine analysis of NRBCs in blood is of high prognostic power with regard to in-hospital mortality. This parameter may serve as an early indicator of patients at increased risk.     

Nucleated red blood cells as predictor of all-cause mortality in emergency department

BacgroundNucleated red blood cells (NRBCs) are immature erythrocytes that are not normally detected in the blood of healthy adults. The detection of these cells in peripheral blood is associated with increased mortality and poor prognosis. In this study, we aimed to investigate whether NRBCs predict for all causes of death in patients admitted to the emergency department (ED).MethodThis study was conducted retrospectively between January 2019 and December 2019 in academic emergency department, faculty of medicine. We included all patients who died of non-traumatic causes and The control group consisted of patients discharged from the ED. NRBCs and other laboratory parameters were compared between the two groups. The primary outcome is all-cause mortality in the ED. Multivariate logistic analysis was performed.ResultsA total of 204 patients (119 male) were included in the study. The mean age of the patients was 66.7 ± 14.6 years. NRBC value was higher in those who died (678.43 ± 655.16/ μl) compared to the control group (22.55 ± 57.86/ μl) (P < 0.001). According to receiver operating characteristic curve analysis (ROC) performed for the prediction all cause mortality in the ED, the best cut-off point for NRBC was >0 /μl (sensitivity 94,12%, specificity 82,35%, Area Under Curve (AUC) =0.97). In the multivariate logistic regression analysis, the NRBC was associated with all-cause mortality in the ED (odds ratio,OR = 1.020, confidence interval, CI = 1.012–1.028).ConclusıonsHigh blood levels of nucleated red blood cells at admission to the emergency department may be associated with increased mortality.     

Quantification of nucleated red blood cells in allogeneic marrow graft and impact of processing on recovery

BACKGROUND: In allogeneic bone marrow transplantation (BMT), a higher nucleated and CD34+ cell dose has been reported to improve various outcomes. Other cell types, such as lymphocyte subsets, also influenced BMT results. While nucleated red blood cells (NRBCs) represent a subset of bone marrow (BM) cell subpopulation, the question of their quantification in BM grafts and the impact of BM processing on their recovery has not been addressed. STUDY DESIGN AND METHODS: In a prospective study on 77 BM products, NRBCs were enumerated by flow cytometry and the recovery analyzed after manipulation. Because NRBCs could compromise white blood cell count, the impact of NRBC count on CD34+ cell percentage and total nucleated cell (TNC) dose were also determined. RESULTS: The mean percentage of NRBCs in BM grafts was 21.6 percent (range, 7.8%-40.9%). Mean NRBC recoveries after BM concentration or RBC depletion were 98.4 and 28.7 percent, respectively, close to those obtained for TNC cells (88.6 and 31.3%, respectively). When corrected with NRBC count, the mean percentages of corrected CD34+ cell and TNC dose were significantly modified when compared with uncorrected values, whatever the type of BM manipulation. CONCLUSION: Our data show that NRBC quantification might be of importance to improve quality control of BM products and to evaluate the influence of NRBCs cell dose on outcomes after BMT.     

Prospective flow cytometric evaluation of nucleated red blood cells in cord blood units and relationship with nucleated and CD34(+) cell quantification

BACKGROUND: Cord blood (CB) represents an alternate source of stem cells in transplantation. Nucleated red blood cells (NRBCs) are a physiological subset of CB population. Although it is important to have an accurate estimate of CD34(+) cell number, NRBCs could compromise white blood cell count and interfere with CD34(+) cell quantification. STUDY DESIGN AND METHODS: A total of 826 CB units were analyzed for total nucleated cells (TNCs), NRBCs, and CD34(+) cells by flow cytometry. NRBCs were also counted conventionally by manual microscopy. Percentages of CD34(+) cells corrected by NRBC count (CD34+c) were determined as follows: %CD34+c = CD34(+)/CD45(+) (x10(6))/(TNCs (x10(8)) - NRBCs (x10(8))). RESULTS: The mean percentages of CD34+ cells and NRBCs were 0.27 percent (range, 0.01%-1.25%) and 7.64 percent (range, 0.13%-84%), respectively. Comparison between flow cytometric and microscopic NRBC count showed a regression of y = 0.685 + 0.719x and a coefficient of determination of r(2) = 0.721. When corrected with NRBC count, the mean percentage of CD34(+) c cells was 0.295 percent (p = 0.0008 compared with CD34(+)%) and mean TNCc count was 14.8 x 10(8) (p < 10(-4) compared to TNC count). CONCLUSION: The determination of NRBCs with a flow cytometric method might represent a new strategy for providing satisfactory quality assurance controls of CB products.     

引物延伸预扩增后STR分型在鉴定母血中胎儿有核红细胞的应用

目的 探讨一种鉴定母血中胎儿有核红细胞（NRBC）的方法，为无创性产前基因诊断创造必要条件。方法 联苯胺染色识别孕妇外周血中NRBC，经显微操作获取，并以引物延伸预扩增（PEP）对单个NRBC进行全基凶组扩增后，用短串联重复序列（STR）分析其基因型，与父母基因型比对，确定该细胞的来源。结果 28例轻型β地中海贫血孕妇外周血样本中每例发现NRBC4～13个／5ml，经鉴定每例有胎儿NRBC2～8个／5ml，约43．6％的NRBC来源于胎儿。结论 PEP后STR基因型分析能有效鉴定孕妇外周血中NRBC的来源，使应用单个胎儿NRBC进行产前基因诊断成为可能。     

CELL-DYN3500R血液分析仪出现部分细胞警示的血涂片分析

目的 探讨CELL-DYN3500R血液分析仪出现的部分细胞警示。方法 选择血液分析仪屏幕上显示有NRBC，RRBC或NWBC警示的血标本直接涂片，瑞氏染色后检查是否出现NRBC及幼稚细胞。结果 警示NRBC、RRBC及NWBC时，显微镜检查出现NRBC的比例为38.1%(159/417),25.6%(22/86)及23.5%(31/132)，出现幼稚细胞的比例分别为7.4%(31/417),17.4%(22/86)及8.3%(11/132)。结论 CELL-DYN3500R警示NRBC，RRBC，NWBC时必须涂片检查予以确证，无任何警示时可以认可仪器的结果，无需涂片镜检。     

Early identification of patients with an acute coronary syndrome as assessed by dispatchers and the ambulance crew

This study was performed to evaluate the possibility of early identification of patients with an acute coronary syndrome who are transported by ambulance. All patients in the community of G?teborg who were transported by ambulance over a period of 3 months owing to symptoms raising any suspicion of an acute coronary syndrome were studied. In all 930 cases that were included in the survey, 130 (14%) had a final diagnosis of acute myocardial infarction (AMI) and 276 (30%) had a final diagnosis of an acute coronary syndrome. Independent risk indicators for development of AMI were: male sex (odds ratio 1.70; 95% confidence limits 1.02-2.84), cold and clammy on admission of the ambulance crew (odds ratio 2.07; 95% confidence limits 1.23-3.49) and showing electrocardiogram (ECG) signs of myocardial ischemia on admission to the emergency department (odds ratio 8.78; 95%confidence limits 5.28-14.61). Independent predictors for development of an acute coronary syndrome were: male sex (odds ratio 1.97; 95% confidence limits 1.30-2.99), a history of angina pectoris (odds ratio 3.41; 95% confidence limits 2.24-5.26), cold and clammy on admission of the ambulance crew (odds ratio 1.95; 95% confidence limits 1.21-3.15), and ECG signs of myocardial ischemia on admission to the emergency department (odds ratio 5.55; 95% confidence limits 3.63-8.58). Among patients seen by the ambulance crew with symptoms raising any suspicion of an acute coronary syndrome, predictors for that diagnosis included male sex, a history of angina pectoris, patients being cold and clammy on admission of the ambulance crew, and ECG signs of myocardial ischemia on admission to the emergency department.     

Erythropoietin to minimize perioperative blood transfusion: a systematic review of randomized trials

Our aim was to perform a systematic review to determine the efficacy and side-effects of erythropoietin, given with or without autologous predonation, to patients undergoing orthopaedic or cardiac surgery. A number of studies have been done to determine whether erythropoietin minimizes exposure to perioperative allogeneic red cell transfusion. A systematic review of all randomized trials will provide the best estimate of the efficacy and side-effects of erythropoietin therapy. All randomized trials of erythropoietin in cardiac or orthopaedic surgery that reported the proportion of patients receiving perioperative allogeneic transfusion were included. The efficacy of erythropoietin was evaluated in subgroups of patients depending upon the route of administration, dose of erythropoietin, the type of control and the methodological quality of the study report. The odds ratio for the proportion of patients transfused with allogeneic blood in studies of erythropoietin to augment autologous donation was 0.42 (95% confidence limits 0.28–0.62; P < 0.0001) for orthopaedic surgery and 0.25 (95% CI 0.08–0.82; P = 0.02) for cardiac surgery. The odds ratio for erythropoietin alone was 0.36 (95% CI 0.24–0.56; P = 0.0001) in orthopaedic surgery and 0.25 (95% CI 0.06–1.04; P < 0.06) in cardiac surgery. The route of administration, dose of erythropoietin, type of control and methodological quality of the study report had no statistically significant effect upon the odds ratios. Although there was no convincing evidence that erythropoietin used alone increased the frequency of thrombotic complications, some studies found an excess of events in erythropoietin-treated patients, and the number of patients studied was relatively small. Erythropoeitin, when given alone or to augment autologous donation, decreased exposure to perioperative allogeneic transfusion in orthopaedic and cardiac surgery. Further studies are required to definitively establish the safety of erythropoietin alone, to determine the optimal dose of perioperative erythropoietin, and to compare its efficacy and cost-effectiveness with other methods of minimizing perioperative transfusion.     

Nucleated red blood cells after cardiopulmonary bypass in infants and children: is there a relationship to the systemic inflammatory response syndrome?

In a retrospective case control study we aimed to evaluate whether infants and children with nucleated red blood cells (NRBCs) in their peripheral blood smears after cardiopulmonary bypass (CPB) had longer bypass times than controls without NRBCs. On review of a 3-year period, 58 children with NRBCs after CPB (and without NRBCs prior to CPB) were identified (cases). A random sample of 100 children without NRBCs after CPB over the same period served as controls. The median age (range) of the children with NRBCs and without NRBCs was 0.6 years (2 days to 20 years) and 1.4 years (2 days to 16 years), respectively (p = 0.03). The children with NRBCs had a significantly longer bypass time than the controls (mean, standard deviation (SD): 114 min, 50 vs 79 min, 46 min; p < 0.0001). For the patients with postoperative polychromasia alone, the mean CPB time (111 min, SD 46 min) was also significantly longer than the respective time in the controls (p < 0.001). Markers of organ dysfunction (renal failure, use of inotropic support, time of endotracheal intubation, stay in intensive care unit and stay in hospital) were significantly more frequent/longer in the NRBC group. Post-CPB release of NRBCs is associated with longer CPB time. This alteration may be part of the CPB-related systemic inflammatory response syndrome.     

Nucleated red blood cells in the blood of medical intensive care patients indicate increased mortality risk: a prospective cohort study

Introduction  

In critically ill patients, the appearance of nucleated red blood cells (NRBCs) in blood is associated with a variety of severe diseases. Generally, when NRBCs are detected in the patients' blood, the prognosis is poor.     

Coronary blood flow reserve response to left anterior descending coronary artery stenting and its value in predicting coronary restenosis.

BACKGROUND: Heterogeneous results of coronary flow velocity reserve (CFVR) to percutaneous procedures have been reported and the impact of transesophageal echocardiographic evaluation of CFVR in predicting restenosis has not been completely established. Methods and results: We studied 20 control volunteers and 51 patients with left anterior descending coronary artery stenosis to determine the CFVR response to left anterior descending coronary artery stenting, the clinical markers of persistent CFVR impairment, and its value in predicting restenosis. Prestent CFVR was lower in the stenosis group than in control volunteers (1.89 +/- 0.66 vs 3.82 +/- 1.15; P <.001). Although there was a significant increase of CFVR after stenting (2.58 +/- 0.76; P <.001 vs prestent), it remained depressed in 53% of patients and was independently related to multivessel disease (odds ratio, 0.14; 95% confidence interval 0.03-0.55; P =.005), age (odds ratio, 1.07; 95% confidence interval 0.99-1.15; P =.056), and prestent CFVR (odds ratio, 3.78; 95% confidence interval 0.99-14.42; P =.051). CFVR measured both before and early after stenting did not differ between patients with and without restenosis. CONCLUSIONS: CFVR impairment occurs in a large proportion of patients despite successful stenting and appears to be consequent of the extent of atherosclerotic coronary disease. Periprocedural CFVR conferred no predictive value for subsequent intrastent restenosis.     

212例血液病贫血患者红细胞参数特点和相关性分析

目的研究血液病性贫血患者红细胞参数的分布规律和相互关系。方法用Sysmex XE-2100全自动血细胞分析仪测定212例不同血液病导致的贫血患者静脉血,分析红细胞平均体积、红细胞体积分布宽度,网织红细胞和有核红细胞比例在不同类型疾病中的分布特点和相互关系。结果不同血液病中,IMF、MM、NHL、PKD患者MCV平均值在正常范围,HS、MA、EVENS、ITP、HA、PNH、AA、CML、MDS、AL患者MCV平均值大于正常,并与RDW和REF同步增高,IDA减小。各种血液病外周有核红细胞平均值增高,增高程度和MCV、RDW和RET相关。结论血液病性贫血患者红细胞参数、有核红及网织红比例变化的同步性强;外周有核红细胞比例增高与疾病和贫血的严重程度有关。     

Procalcitonin and interleukin 6 for predicting blood culture positivity in sepsis

Background

Procalcitonin and interleukin 6 (IL-6) are well-known predictors of blood culture positivity in patients with sepsis. However, the association of procalcitonin and IL-6 with blood culture positivity was assessed separately in previous studies. This study aims to examine and compare the performance of procalcitonin and IL-6, measured concomitantly, in predicting blood culture positivity in patients with sepsis.

Methods

Forty adult patients with sepsis were enrolled in the study. Blood cultures were drawn before the institution of antibiotic therapy. The area under the curve (AUC) of the receiver operating characteristic curve was estimated to assess the performance of procalcitonin and IL-6 in predicting blood culture positivity.

Results

Positive blood cultures were detected in 10 patients (25%). The AUC of procalcitonin and IL-6 was 0.85 and 0.61, respectively. The combined performance of procalcitonin and IL-6 was similar to that of procalcitonin alone, AUC of 0.85. On univariate analysis, only procalcitonin and IL-6 were associated with blood culture positivity. Multivariate logistic regression analysis showed that only procalcitonin was associated with blood culture positivity (odds ratio, 12.15 [1.29-114.0] for levels above the median compared with levels below the median). Using procalcitonin cut points of 1.35 and 2.14 (nanogram per milliliter) enabled 100% and 90% identification of positive blood cultures and reduced the need of blood cultures by 47.5% and 57.5%, respectively.

Conclusions

Compared with IL-6, procalcitonin better predicts blood culture positivity in patients with sepsis. Using a predefined procalcitonin cut points will predict most positive blood cultures and reduce the need of blood cultures in almost half of patients with sepsis.     

Differences in post-operative infection rates between patients receiving autologous and allogeneic blood transfusion: a meta-analysis of published randomized and nonrandomized studies

Summary. We have undertaken a meta-analysis of the post-operative infection rates in patients who received autologous blood compared with allogeneic blood. Nine studies published after 1989 were identified, of which seven had sufficient data on transfusion given in the paper to be included, giving a total of 1060 patients. The risk of post-operative infection was greater in the allogeneic group, odds ratio 2.37 (95% confidence interval (CI) 1.6-3.6, P < 0.0001) compared with the autologous group. Allogeneic and autologous blood transfusion should be compared in a large multicentre randomized control trial.     

应用新型抗胎儿血红蛋白抗体富集母体循环中胎儿有核红细胞

目的 利用多肽合成技术制备抗胎儿血红蛋白(fetal hem-oglobin,HBF)γ链的抗体,探讨其用于检测孕妇外周血中胎儿有核红细胞(nucleated red blood cell,NRBC)进行无创性产前基因诊断的可行性.方法 针对胎儿血红蛋白的特异性抗原表位,选定第69～78位HbF-γ特异的11个氨基酸残基的肽段为免疫原,将人工合成的胎儿血红蛋白γ链的多肽与载体蛋白(KLH)偶联,佐剂乳化后免疫羊,制备羊抗人胎儿血红蛋白的抗血清,经蛋白G纯化,HbF特异性抗体标记、识别、显微操作法富集32例孕周为22～39周的孕妇外周血中的胎儿有核红细胞,引物延伸预扩增后,利用9个短串联重复序列(short tandem repeat,STR)的复合扩增方法对富集的阳性细胞进行扩增,用于孕妇外周血中富集的HbF阳性细胞胎儿来源的遗传学鉴定.结果 经HbF多克隆抗体标记,32名孕妇外周血中均发现与HbF呈阳性反应的胎儿NRBC,并具有鲜明的形态学特征,光学显微镜下可见NRBC细胞质呈棕黄色,核浆比例较低,苏木素复染后胞核呈蓝色,明显区别于其他细胞,每份样本出现NRBC 0.6～1.8个/ml,共计183个,平均为1.3个/ml,经STR多态性基因位点鉴定,准确率为90.6%.结论 利用多肽合成技术制备的抗胎儿血红蛋白γ链的抗体能有效识别母血中的胎儿有核红细胞,可应用于无创性产前基因诊断,具备良好的应用前景.